NPIMap

Organization Active NPI

Integrated Medical Group LTD

  • Chiropractor
  • Glen Carbon, IL
National Provider Identifier
1871984336
Registry record updated Feb 5, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038.012734 Issued in IL
Legal business name
INTEGRATED MEDICAL GROUP LTD
Practice address
8 Ginger Creek Pkwy
Glen Carbon, IL 62034-3502
Phone
(618) 692-6700
Fax
(618) 692-6711
NPI assigned
Feb 5, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. David Michael Thayer, DC,FIAMA,DIPL.ACNPI 1689642951
Title
Owner
Phone
(618) 692-6700

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 038.012734 IL Primary

Addresses

Primary practice location

8 Ginger Creek Pkwy
Glen Carbon, IL 62034-3502

Mailing address

PO Box 997
Edwardsville, IL 62025-0997
Phone (618) 692-6700

National Provider Directory

National Provider Directory
Tax ID family
Integrated Medical Group LTD9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1423094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423094400000",
    "number": "1871984336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 997",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620250997",
            "telephone_number": "618-692-6700",
            "fax_number": "618-692-6711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8 GINGER CREEK PKWY",
            "city": "GLEN CARBON",
            "state": "IL",
            "postal_code": "620343502",
            "telephone_number": "618-692-6700",
            "fax_number": "618-692-6711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED MEDICAL GROUP LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-05",
        "last_updated": "2015-02-05",
        "status": "A",
        "authorized_official_last_name": "THAYER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "618-692-6700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC,FIAMA,DIPL.AC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038.012734",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Carbon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.